Heart Disease and Stroke Statistics—2012 Update
Authors: Véronique L. Roger, Alan S. Go, Donald M. Lloyd-Jones, Emelia J. Benjamin, Jarett D. Berry, William B. Borden, Dawn M. Bravata, Shifan Dai, Earl S. Ford, Caroline S. Fox, Heather J. Fullerton, Cathleen Gillespie, Susan M. Hailpern, John A. Heit, Virginia J. Howard, Brett M. Kissela, Steven J. Kittner, Daniel T. Lackland, Judith H. Lichtman, Lynda D. Lisabeth, Diane M. Makuc, Gregory M. Marcus, Ariane Marelli, David B. Matchar, Claudia S. Moy, Dariush Mozaffarian, Michael E. Mussolino, Graham Nichol, Nina P. Paynter, Elsayed Z. Soliman, Paul D. Sorlie, Nona Sotoodehnia, Tanya N. Turan, Salim S. Virani, Nathan D. Wong, Daniel Woo, Melanie B. Turner
Journal: Circulation (2011)

HomeCirculationVol. 125, No. 1Heart Disease and Stroke Statistics—2012 Update Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBHeart Disease and Stroke Statistics—2012 UpdateA Report From the American Heart Association Writing Group Members Véronique L. Roger, MD, MPH, FAHA, Alan S. Go, MD, Donald M. Lloyd-Jones, MD, ScM, FAHA, Emelia J. Benjamin, MD, ScM, FAHA, Jarett D. Berry, MD, William B. Borden, MD, Dawn M. Bravata, MD, Shifan Dai, MD, PhD, Earl S. Ford, MD, MPH, FAHA, Caroline S. Fox, MD, MPH, Heather J. Fullerton, MD, Cathleen Gillespie, MS, Susan M. Hailpern, DPH, MS, John A. Heit, MD, FAHA, Virginia J. Howard, PhD, FAHA, Brett M. Kissela, MD, Steven J. Kittner, MD, FAHA, Daniel T. Lackland, DrPH, MSPH, FAHA, Judith H. Lichtman, PhD, MPH, Lynda D. Lisabeth, PhD, FAHA, Diane M. Makuc, DrPH, Gregory M. Marcus, MD, MAS, FAHA, Ariane Marelli, MD, MPH, David B. Matchar, MD, FAHA, Claudia S. Moy, PhD, MPH, Dariush Mozaffarian, MD, DrPH, FAHA, Michael E. Mussolino, PhD, Graham Nichol, MD, MPH, FAHA, Nina P. Paynter, PhD, MHSc, Elsayed Z. Soliman, MD, MSc, MS, Paul D. Sorlie, PhD, Nona Sotoodehnia, MD, MPH, Tanya N. Turan, MD, FAHA, Salim S. Virani, MD, Nathan D. Wong, PhD, MPH, FAHA, Daniel Woo, MD, MS, FAHA and Melanie B. Turner, MPHon behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Writing Group Members Search for more papers by this author , Véronique L. RogerVéronique L. Roger Search for more papers by this author , Alan S. GoAlan S. Go Search for more papers by this author , Donald M. Lloyd-JonesDonald M. Lloyd-Jones Search for more papers by this author , Emelia J. BenjaminEmelia J. Benjamin Search for more papers by this author , Jarett D. BerryJarett D. Berry Search for more papers by this author , William B. BordenWilliam B. Borden Search for more papers by this author , Dawn M. BravataDawn M. Bravata Search for more papers by this author , Shifan DaiShifan Dai *The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Search for more papers by this author , Earl S. FordEarl S. Ford *The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Search for more papers by this author , Caroline S. FoxCaroline S. Fox Search for more papers by this author , Heather J. FullertonHeather J. Fullerton Search for more papers by this author , Cathleen GillespieCathleen Gillespie *The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Search for more papers by this author , Susan M. HailpernSusan M. Hailpern Search for more papers by this author , John A. HeitJohn A. Heit Search for more papers by this author , Virginia J. HowardVirginia J. Howard Search for more papers by this author , Brett M. KisselaBrett M. Kissela Search for more papers by this author , Steven J. KittnerSteven J. Kittner Search for more papers by this author , Daniel T. LacklandDaniel T. Lackland Search for more papers by this author , Judith H. LichtmanJudith H. Lichtman Search for more papers by this author , Lynda D. LisabethLynda D. Lisabeth Search for more papers by this author , Diane M. MakucDiane M. Makuc *The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Search for more papers by this author , Gregory M. MarcusGregory M. Marcus Search for more papers by this author , Ariane MarelliAriane Marelli Search for more papers by this author , David B. MatcharDavid B. Matchar Search for more papers by this author , Claudia S. MoyClaudia S. Moy Search for more papers by this author , Dariush MozaffarianDariush Mozaffarian Search for more papers by this author , Michael E. MussolinoMichael E. Mussolino Search for more papers by this author , Graham NicholGraham Nichol Search for more papers by this author , Nina P. PaynterNina P. Paynter Search for more papers by this author , Elsayed Z. SolimanElsayed Z. Soliman Search for more papers by this author , Paul D. SorliePaul D. Sorlie Search for more papers by this author , Nona SotoodehniaNona Sotoodehnia Search for more papers by this author , Tanya N. TuranTanya N. Turan Search for more papers by this author , Salim S. ViraniSalim S. Virani Search for more papers by this author , Nathan D. WongNathan D. Wong Search for more papers by this author , Daniel WooDaniel Woo Search for more papers by this author and Melanie B. TurnerMelanie B. Turner Search for more papers by this author and on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Originally published15 Dec 2011https://doi.org/10.1161/CIR.0b013e31823ac046Circulation. 2012;125:e2–e220is corrected byCorrectionsOther version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2011: Previous Version 1 Table of ContentsSummary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e3About These Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e7American Heart Association's 2020 Impact Goals. . . . . . . . . . . . . . . . .e10Cardiovascular Diseases . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .e21Subclinical Atherosclerosis . . . . . . . . . . . . . . . . . . . . .e45Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris . . . . . . . . .e54Stroke (Cerebrovascular Disease) . . . . . . . . . . . . . . . . . . . . . . . . . . . .e68High Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .e88Congenital Cardiovascular Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . .e97Cardiomyopathy and Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . .e102Disorders of Heart Rhythm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e107Other Cardiovascular Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .e122Risk Factor: Family History and Genetics . . . . . . . . . . . . . . . . . . . . . . . .e130Risk Factor: Smoking/Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . .e134Risk Factor: High Blood Cholesterol and Other Lipids . . . . . . . . . . . . . . . . . . . .e139Risk Factor: Physical Inactivity . . . . . . . . . . . . . . . . . . . . . . . . . . . .e145Risk Factor: Overweight and Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . .e152Risk Factor: Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e160End-Stage Renal Disease and Chronic Kidney Disease . . . . . . . . . . . . . . . . . . . .e170Metabolic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e175Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e180Quality of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .e193Medical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e204Economic Cost of Cardiovascular Disease . . . . . . . . . . . . . . . . . . . . . .. . . . .e209At-a-Glance Summary Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e213Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e218Roger Véronique L., MD, MPH, FAHATurner Melanie B., MPHand On behalf of the American Heart Association Statistics Committee and Stroke Statistics SubcommitteeSummaryEach year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best national data available on disease morbidity and mortality and the risks, quality of care, medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited more than 8700 times in the literature (including citations of all annual versions). In 2010 alone, the various Statistical Updates were cited ≈1600 times (data from ISI Web of Science). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas. For this year's edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year and added a new chapter detailing various disorders of heart rhythm. Also, the 2012 Statistical Update is a major source for monitoring both cardiovascular health and disease in the population, with a focus on progress toward achievement of the AHA's 2020 Impact Goals. Below are a few highlights from this year's Update.Rates of Death Attributable to CVD Have Declined, Yet the Burden of Disease Remains HighThe 2008 overall rate of death attributable to cardiovascular disease (CVD) (International Classification of Diseases, 10th Revision, codes I00–I99) was 244.8 per 100 000. The rates were 287.2 per 100 000 for white males, 390.4 per 100 000 for black males, 200.5 per 100 000 for white females, and 277.4 per 100 000 for black females.From 1998 to 2008, the rate of death attributable to CVD declined 30.6%. Mortality data for 2008 show that CVD (I00–I99; Q20–Q28) accounted for 32.8% (811 940) of all 2 471 984 deaths in 2008, or 1 of every 3 deaths in the United States.On the basis of 2008 mortality rate data, more than 2200 Americans die of CVD each day, an average of 1 death every 39 seconds. About 150 000 Americans killed by CVD (I00–I99) in 2008 were <65 years of age. In 2008, 33% of deaths due to CVD occurred before the age of 75 years, which is well before the average life expectancy of 77.9 years.Coronary heart disease caused ≈1 of every 6 deaths in the United States in 2008. Coronary heart disease mortality in 2008 was 405 309. Each year, an estimated 785 000 Americans will have a new coronary attack, and ≈470 000 will have a recurrent attack. It is estimated that an additional 195 000 silent first myocardial infarctions occur each year. Approximately every 25 seconds, an American will have a coronary event, and approximately every minute, someone will die of one.Each year, ≈795 000 people experience a new or recurrent stroke. Approximately 610 000 of these are first attacks, and 185 000 are recurrent attacks. Mortality data from 2008 indicate that stroke accounted for ≈1 of every 18 deaths in the United States. On average, every 40 seconds, someone in the United States has a stroke. From 1998 to 2008, the stroke death rate fell 34.8%, and the actual number of stroke deaths declined 19.4%.In 2008, 1 in 9 death certificates (281 437 deaths) in the United States mentioned heart failure.Prevalence and Control of Traditional Risk Factors Remains an Issue for Many AmericansData from the National Health and Nutrition Examination Survey (NHANES) 2005–2008 indicate that 33.5% of US adults ≥20 years of age have hypertension (Table 7-1). This amounts to an estimated 76 400 000 US adults with hypertension. The prevalence of hypertension is nearly equal between men and women. African American adults have among the highest rates of hypertension in the world, at 44%.Among hypertensive adults, ≈80% are aware of their condition, 71% are using antihypertensive medication, and only 48% of those aware that they have hypertension have their condition controlled.Despite 4 decades of progress, in 2010, among Americans ≥18 years of age, 21.2% of men and 17.5% of women continued to be cigarette smokers. In 2009, 19.5% of students in grades 9 through 12 reported current cigarette use.The percentage of the nonsmoking population with detectable serum cotinine (indicating exposure to secondhand smoke) declined from 52.5% in 1999 to 2000 to 40.1% in 2007 to 2008, with declines occurring, and was higher for those 3 to 11 years of age (53.6%) and those 12 to 19 years of age (46.5%) than for those 20 years of age and older (36.7%).An estimated 33 600 000 adults ≥20 years of age have total serum cholesterol levels ≥240 mg/dL, with a prevalence of 15.0% (Table 14-1).In 2008, an estimated 18 300 000 Americans had diagnosed diabetes mellitus, representing 8.0% of the adult population. An additional 7 100 000 had undiagnosed diabetes mellitus, and 36.8% had prediabetes, with abnormal fasting glucose levels. African Americans, Mexican Americans, Hispanic/Latino individuals, and other ethnic minorities bear a strikingly disproportionate burden of diabetes mellitus in the United States (Table 17-1).The 2012 Update Expands Data Coverage of the Obesity Epidemic and Its Antecedents and ConsequencesThe estimated prevalence of overweight and obesity in US adults (≥20 years of age) is 149 300 000, which represents 67.3% of this group in 2008. Fully 33.7% of US adults are obese (body mass index ≥30 kg/m2). Men and women of all race/ethnic groups in the population are affected by the epidemic of overweight and obesity (Table 16-1).Among children 2 to 19 years of age, 31.7% are overweight and obese (which represents 23.6 million children), and 16.9% are obese (12.6 million children). Mexican American boys and girls and African American girls are disproportionately affected. Over the past 3 decades, the prevalence of obesity in children 6 to 11 years of age has increased from ≈4% to >20%.Obesity (body mass index ≥30 kg/m2) is associated with marked excess mortality in the US population. Even more notable is the excess morbidity associated with overweight and obesity in terms of risk factor development and incidence of diabetes mellitus, CVD end points (including coronary heart disease, stroke, and heart failure), and numerous other health conditions, including asthma, cancer, degenerative joint disease, and many others.The prevalence of diabetes mellitus is increasing dramatically over time, in parallel with the increases in prevalence of overweight and obesity.On the basis of NHANES 2003–2006 data, the age-adjusted prevalence of metabolic syndrome, a cluster of major cardiovascular risk factors related to overweight/obesity and insulin resistance, is ≈34% (35.1% among men and 32.6% among women).The proportion of youth (≤18 years of age) who report engaging in no regular physical activity is high, and the proportion increases with age. In 2009, among adolescents in grades 9 through 12, 29.9% of girls and 17.0% of boys reported that they had not engaged in 60 minutes of moderate-to-vigorous physical activity, defined as any activity that increased heart rate or breathing rate, even once in the previous 7 days, despite recommendations that children engage in such activity ≥5 days per week.Thirty-three percent of adults reported engaging in no aerobic leisure-time physical activity.Data from NHANES indicate that between 1971 and 2004, average total energy consumption among US adults increased by 22% in women (from 1542 to 1886 kcal/d) and by 10% in men (from 2450 to 2693 kcal/d; see Chart 20-1).The increases in calories consumed during this time period are attributable primarily to greater average carbohydrate intake, in particular, of starches, refined grains, and sugars. Other specific changes related to increased caloric intake in the United States include larger portion sizes, greater food quantity and calories per meal, and increased consumption of sugar-sweetened beverages, snacks, commercially prepared (especially fast food) meals, and higher energy-density foods.The 2012 Update Provides Critical Data About Cardiovascular Quality of Care, Procedure Utilization, and CostsIn light of the current national focus on healthcare utilization, costs, and quality, it is critical to monitor and understand the magnitude of healthcare delivery and costs, as well as the quality of healthcare delivery, related to CVDs. The Statistical Update provides these critical data in several sections.Quality-of-Care Metrics for CVDsChapter 21 reviews many metrics related to the quality of care delivered to patients with CVDs, as well as healthcare disparities. In particular, quality data are available from the AHA's “Get With The Guidelines” programs for coronary artery disease and heart failure and from the American Stroke Association/AHA's “Get With The Guidelines” program for acute stroke. Similar data from the Veterans Healthcare Administration, national Medicare and Medicaid data, and Acute Coronary Treatment and Intervention Outcomes Network–“Get With The Guidelines” Registry data are also reviewed. These data show impressive adherence with guideline recommendations for many, but not all, metrics of quality of care for these hospitalized patients. Data are also reviewed on screening for cardiovascular risk factor levels and control.Cardiovascular Procedure Utilization and CostsChapter 22 provides data on trends and current usage of cardiovascular surgical and invasive procedures. For example, the total number of inpatient cardiovascular operations and procedures increased 22%, from 6 133 000 in 1999 to 7 453 000 in 2009 (National Heart, Lung, and Blood Institute computation based on National Center for Health Statistics annual data).Chapter 23 reviews current estimates of direct and indirect healthcare costs related to CVDs, stroke, and related conditions using Medical Expenditure Panel Survey data. The total direct and indirect cost of CVD and stroke in the United States for 2008 is estimated to be $297.7 billion. This figure includes health expenditures (direct costs, which include the cost of physicians and other professionals, hospital services, prescribed medications, home health care, and other medical durables) and lost productivity resulting from mortality (indirect costs). By comparison, in 2008, the estimated cost of all cancer and benign neoplasms was $228 billion ($93 billion in direct costs, $19 billion in morbidity indirect costs, and $116 billion in mortality indirect costs). CVD costs more than any other diagnostic group.The AHA, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current data available in the Statistics Update.Finally, it must be noted that this annual Statistical Update is the product of an entire year's worth of effort by dedicated professionals, volunteer physicians and scientists, and outstanding AHA staff members, without whom publication of this valuable resource would be impossible. Their contributions are gratefully acknowledged.Véronique L. Roger, MD, MPH, FAHAMelanie B. Turner, MPHOn behalf of the American Heart Association Statistics Committee and Stroke Statistics SubcommitteeNote: Population data used in the compilation of NHANES prevalence estimates is for the latest year of the NHANES survey being used. Extrapolations for NHANES prevalence estimates are based on the census resident population for 2008 because this is the most recent year of NHANES data used in the Statistical Update.AcknowledgmentsWe wish to thank Thomas Thom, Michael Wolz, Dale Burwen, and Sean Coady for their valuable comments and contributions. We would like to acknowledge Karen Modesitt for her administrative assistance.DisclosuresWriting Group DisclosuresWriting Group MemberEmploymentResearch GrantOther Research SupportSpeakers' Bureau/HonorariaExpert WitnessOwnership InterestConsultant/Advisory BoardOtherVéronique L. RogerMayo ClinicNoneNoneNoneNoneNoneNoneNoneEmelia J. BenjaminBoston University School of MedicineNIH†NoneNoneNoneNoneNIH†NoneJarett D. BerryUT Southwestern Medical SchoolAHA†; NHLBI†NoneMerck†NoneNoneNoneNoneWilliam B. BordenWeill Cornell Medical CollegeNoneNoneNoneNoneNoneNoneThe Dr. Robert C. and Veronica Atkins Foundation provided an educational grant to develop a curriculum in Metabolic Diseases; Dr Borden receives salary support from that†Dawn M. BravataUniversity of IowaNoneNoneNoneNoneNoneNoneNoneShifan DaiCenters for Disease Control and PreventionNoneNoneNoneNoneNoneNoneNoneEarl S. FordCenters for Disease Control and PreventionNoneNoneNoneNoneNoneNoneNoneCaroline S. FoxNHLBINoneNoneNoneNoneNoneNoneNoneHeather J. FullertonUniversity of California, San FranciscoNIH/NINDS†NoneCincinnati Children's Hospital*; Toronto Hospital for Sick Children*NoneNoneDSMB for Berlin Heart*NoneCathleen GillespieCenters for Disease Control and PreventionNoneNoneNoneNoneNoneNoneNoneAlan S. GoThe Permanente Medical GroupGlaxoSmithKline†; Johnson & Johnson†NoneNoneNoneNoneNoneNoneSusan M. HailpernIndependent ConsultantNoneNoneNoneNoneNoneNoneNoneJohn A. HeitMayo ClinicNoneNoneNoneNoneNoneNoneNoneVirginia J. HowardUniversity of Alabama at Birmingham School of Public HealthNIH/NINDS†NoneNoneNoneNoneNoneNoneBrett M. KisselaUniversity of CincinnatiNexstim*NoneAllergan*Expert witness for defense in 1 stroke-related case in 2010†NoneAllergan*NoneSteven J. KittnerUniversity of Maryland School of MedicineNoneNoneNoneNoneNoneNoneNoneDaniel T. LacklandMedical University of South CarolinaNoneNoneNoneNoneNoneNoneNoneJudith H. LichtmanYale School of MedicineNoneNoneNoneNoneNoneNoneNoneLynda D. LisabethUniversity of MichiganNHLBI†; NINDS†NoneNoneNoneNoneNoneNoneDonald M. Lloyd-JonesNorthwestern UniversityNoneNoneNoneNoneNoneNoneNoneDiane M. MakucNational Center for Health Statistics, CDCNoneNoneNoneNoneNoneNoneNoneGregory M. MarcusUCSFAstellas*; Baylis Medical*NoneNoneNoneNoneNoneNoneAriane MarelliMcGill University Health CenterNoneNoneNoneNoneNoneNoneNoneDavid B. MatcharDuke-NUS Graduate Medical SchoolNoneNoneNoneNoneNoneBoehringer Ingelheim*NoneClaudia S. MoyNational Institutes of HealthNoneNoneNoneNoneNoneNoneNoneDariush MozaffarianDivision of Cardiovascular Medicine, Brigham and Women's Hospital/Harvard School of Public HealthNIH†; Genes and Environment Initiative at Harvard School of Public Health†; Gates Foundation/World Health Organization†; GlaxoSmithKline†; Pronova†; Searle Scholar Award from the Searle Funds at the Chicago Community Trust†; Sigma Tau†NoneAramark*; the Chicago Council*; International Life Sciences Institute*; Norwegian Seafood Export Council*; Nutrition Impact*; SPRIM*; Unilever*; UN Food and Agricultural Organization*; US Food and Drug Administration*; World Health Organization*NoneHarvard has filed a provisional patent application that been assigned to Harvard, listing Dr Mozaffarian as a coinventor for use of trans-palmitoleic acid to prevent and treat insulin resistance, type 2 diabetes, and related conditions*; royalties from UpToDate for an online chapter*FoodMinds*NoneMichael E. MussolinoNational Heart, Lung, and Blood InstituteNoneNoneNoneNoneNoneNoneNoneGraham NicholUniversity of WashingtonAsmund S. Laerdal Foundation for Acute Medicine†; Medtronic Inc†; NHLBI†; NIH†NoneNoneNoneNoneGambro Renal Inc*; LIFEBRIDGE Medizintechnik AG*; Sotera Wireless*NoneNina P. PaynterBrigham and Women's HospitalCelera Corp†; NIH/NHLBI†NoneNoneNoneNoneNoneNoneElsayed Z. SolimanWake Forest University School of MedicineNoneNoneNoneNoneNoneNoneNonePaul D. SorlieNational Heart, Lung and Blood Institute, NIHNoneNoneNoneNoneNoneNoneNoneNona SotoodehniaUniversity of WashingtonNoneNoneNoneNoneNoneNoneNoneTanya N. TuranMedical University of South CarolinaNIH/NINDS†AstraZeneca supplied drug for SAMMPRIS study†; Stryker Co supplied stents for SAMMPRIS study†NoneNoneNoneBoehringer Ingelheim*; CardioNet*; WL Gore*NoneMelanie B. TurnerAmerican Heart AssociationNoneNoneNoneNoneNoneNoneNoneSalim S. ViraniDepartment of Veterans AffairsMerck†; NFL Charities†; NIH†; VA†NoneNoneNoneNoneNoneNoneNathan D. WongUniversity of California, IrvineBristol-Myers Squibb†; Merck†NoneNoneNoneNoneAbbott Pharmaceuticals*NoneDaniel WooUniversity of CincinnatiNIH†NoneNoneNoneNoneNoneNoneThis table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10 000 or more during any 12-month period, or 5% or more of the person's gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition.*Modest.†Significant.1. About These StatisticsThe American Heart Association (AHA) works with the Centers for Disease Control and Prevention's (CDC's) National Center for Health Statistics (NCHS); the National Heart, Lung, and Blood Institute (NHLBI); the National Institute of Neurological Disorders and Stroke (NINDS); and other government agencies to derive the annual statistics in this Heart Disease and Stroke Statistical Update. This chapter describes the most important sources and the types of data we use from them. For more details, see Chapter 25 of this document, the Glossary.The surveys used are: Behavioral Risk Factor Surveillance System (BRFSS)—ongoing telephone health survey systemGreater Cincinnati/Northern Kentucky Stroke Study (GCNKSS)—stroke incidence rates and outcomes within a biracial populationMedical Expenditure Panel Survey (MEPS)—data on specific health services that Americans use, how frequently they use them, the cost of these services, and how the costs are paidNational Health and Nutrition Examination Survey (NHANES)—disease and risk factor prevalence and nutrition statisticsNational Health Interview Survey (NHIS)—disease and risk factor prevalenceNational Hospital Discharge Survey (NHDS)—hospital inpatient discharges and procedures (discharged alive, dead, or status unknown)National Ambulatory Medical Care Survey (NAMCS)—physician office visitsNational Home and Hospice Care Survey (NHHCS)—staff, services, and patients of home health and hospice agenciesNational Hospital Ambulatory Medical Care Survey (NHAMCS)—hospital outpatient and emergency department (ED) visitsNationwide Inpatient Sample of the Agency for Healthcare Research and Quality—hospital inpatient discharges, procedures, and chargesNational Nursing Home Survey (NNHS)—nursing home residentsNational Vital Statistics System—national and state mortality dataWorld Health Organization—mortality rates by countryYouth Risk Behavior Surveillance System (YRBSS)—health-risk behaviors in youth and young adultsAbbreviations Used in Chapter 1AHAAmerican Heart AssociationAPangina pectorisARICAtherosclerosis Risk in Communities StudyBPblood pressureBRFSSBehavioral Risk Factor Surveillance SystemCDCCenters for Disease Control and PreventionCHSCardiovascular Health StudyCVDcardiovascular diseaseDMdiabetes mellitusEDemergency departmentFHSFramingham Heart StudyGCNKSSGreater Cincinnati/Northern Kentucky Stroke StudyHDheart diseaseHFheart failureICDInternational Classification of DiseasesICD-9-CMInternational Classification of Diseases, Clinical Modification, 9th RevisionICD-10International Classification of Diseases, 10th RevisionMEPSMedical Expenditure Panel SurveyMImyocardial infarctionNAMCSNational Ambulatory Medical Care SurveyNCHSNational Center for Health StatisticsNHAMCSNational Hospital Ambulatory Medical Care SurveyNHANESNational Health and Nutrition Examination SurveyNHDSNational Hospital Discharge SurveyNHHCSNational Home and Hospice Care SurveyNHISNational Health Interview SurveyNHLBINational Heart, Lung, and Blood InstituteNINDSNational Institute of Neurological Disorders and StrokeNNHSNational Nursing Home SurveyPADperipheral artery diseaseYRBSSYouth Risk Behavior Surveillance SystemSee Glossary (Chapter 25) for explanation of terms.Disease PrevalencePrevalence is an estimate of how many people have a disease at a given point or period in time. The NCHS conducts health examination and health interview surveys that provide estimates of the prevalence of diseases and risk factors. In this Update, the health interview part of the NHANES is used for the prevalence of cardiovascular diseases (CVDs). NHANES is used more than the NHIS because in NHANES, angina pectoris (AP) is based on the Rose Questionnaire; estimates are made regularly for heart failure (HF); hypertension is based on blood pressure (BP) measurements and interviews; and an estimate can be made for total CVD, including myocardial infarction (MI), AP, HF, stroke, and hypertension.A major emphasis of this Statistical Update is to present the latest estimates of the number of people in the United States who have specific conditions to provide a realistic estimate of burden. Most estimates based on NHANES prevalence rates are based on data collected from 2005 to 2008 (in most cases, these are the latest published figures). These are applied to census population estimates for 2008. Differences in population estimates based on extrapolations of rates beyond the data collection pe